Ellis Edmunds, is a
Psychologist - Clinical based in Oakland, California. Ellis Edmunds is licensed to practice in California (license number PSY27058) and his current practice location is
4243 Terrace St, Oakland, California. He can be reached at his office (for appointments etc.) via phone at
(510) 919-8366.
NPI number for Ellis Edmunds is 1740595768 and his current mailing address is 4243 Terrace St, Oakland, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1740595768.
Healthcare Provider's Profile
| Full Name | Ellis Edmunds |
|---|
| Gender | Male |
|---|
| Speciality | Psychologist - Clinical |
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| Location | 4243 Terrace St, Oakland, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1740595768
- Provider Enumeration Date: 08/13/2010
- Last Update Date: 07/22/2020
Medical Identifiers
Medical identifiers for Ellis Edmunds such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1740595768 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | PSY27058 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ellis Edmunds is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ellis Edmunds,
4243 Terrace St,
Oakland, CA 94611-5127
Ph: (510) 919-8366 | Ellis Edmunds,
4243 Terrace St,
Oakland, CA 94611-5127
Ph: (510) 919-8366 |
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